Preconception health of low socioeconomic status women: assessing knowledge and behaviors

The stalled U.S. infant mortality rate and persistent disparities in adverse pregnancy outcomes may be addressed by optimizing a woman's health throughout her childbearing years. This study examines women's knowledge and behaviors related to preconception risk factors in two community health centers serving lower income, racially diverse populations.

A survey was administered among a convenience sample of women ages 18 to 44 years (n = 340). Questions focused on health behaviors and conditions, knowledge of risk factors, and recommendations of health care providers. Outcomes include the prevalence of risk factors and correlations between the presence of a risk factor and either a respondent's knowledge or a health care provider's recommendation. Data were analyzed for total respondents and two subgroups: Black, non-Hispanic and Hispanic.

Despite strong knowledge of risk factors in the preconception period, high-risk behaviors and conditions existed: 63% of women overweight or obese, 20% drinking alcohol, and 42% taking a multivitamin. Significant differences in risk factors were noted between Black, non-Hispanic and Hispanic respondents. Overweight/obesity (t = 3.0; p < .05) and alcohol use (χ² = 9.2; p < .05) were higher among Black, non-Hispanics, whereas Hispanic women had lower rates of multivitamin use (χ² = 11.1; p < .05). The majority of respondents recall being spoken to by a health care provider about pregnancy-related risks. Most risk factors were not influenced by provider's recommendations, including multivitamin use, drinking alcohol, and smoking. However, birth control use was correlated with a provider's recommendation (χ² = 7.6; p < .05). Correlations between the presence of risk factors and respondent's knowledge existed for immunizations (χ² = 9.6; p < .05), but not for multivitamin use, drinking alcohol, or smoking.

Our study identified behaviors amenable to change. Knowledge alone or a doctor's recommendation are not enough to change those behaviors. Innovative programs and support systems are required to encourage women to adopt healthy behaviors throughout the childbearing years.